Getting a proper diagnosis for metabolic dysfunction-associated steatohepatitis is a careful process that involves looking at your medical history, blood work, imaging of your liver, and sometimes a small tissue sample. Because this condition usually doesn’t cause symptoms until the liver is significantly damaged, knowing when and how to get tested can make all the difference in protecting your liver health.

Introduction: Who Should Get Tested for MASH

If you have certain health conditions or risk factors, your doctor may recommend that you undergo testing for metabolic dysfunction-associated steatohepatitis, or MASH. This condition is serious because it involves not just fat buildup in the liver, but also inflammation and damage to liver cells. The challenge is that MASH often develops silently over many years without causing noticeable symptoms until the liver damage becomes severe.^[1]

You should talk to your healthcare provider about getting tested if you have conditions like obesity, type 2 diabetes, high cholesterol, high triglycerides, or high blood pressure. These are all closely linked to MASH. Even if you don’t have symptoms, regular checkups are important when you have these risk factors, because early detection allows for treatment that can slow down or even reverse liver damage.^[1]

People who are overweight or have insulin resistance—a condition where your body’s cells don’t respond properly to the hormone that manages blood sugar—are also at higher risk. Some people may develop MASH even without being overweight, but they usually have other metabolic problems like abnormal cholesterol levels.^[1]

It’s especially important to seek testing if you experience symptoms such as ongoing fatigue, discomfort or pain in the upper right side of your belly where the liver sits, unexplained weight loss, muscle weakness, swelling in your belly or legs, or a yellowish color in your skin and eyes. However, many people with MASH have no symptoms at all in the early stages, which is why screening based on risk factors is so important.^[1]

Diagnostic Methods for MASH

Diagnosing MASH involves several steps and different types of tests. Your healthcare provider will start by reviewing your medical history and performing a physical examination. They will ask about conditions that increase your risk of developing MASH, such as metabolic disorders, and will check for signs of liver problems during the physical exam.^[1]

Blood Tests

Blood tests are usually the first step in checking for possible liver problems. These tests look for signs of damage or inflammation in your liver. Your doctor may order several different blood tests to get a complete picture of your liver health.^[1]

A complete blood count (CBC) checks the overall health of your blood cells. A basic metabolic panel (BMP) measures various chemicals in your blood to see how your organs are working. A lipid panel measures cholesterol and triglyceride levels, which are often abnormal in people with MASH. The Hemoglobin A1C test measures your average blood sugar levels over the past few months and helps identify diabetes or prediabetes.^[1]

These blood tests can show elevated liver enzyme levels, which may indicate liver inflammation or damage. However, blood tests alone cannot definitively diagnose MASH or determine how much scarring exists in your liver. They are useful as screening tools and help your doctor decide if further testing is needed.^[1]

Imaging Tests

Imaging tests create pictures of the inside of your liver so doctors can look for changes that might indicate MASH. These tests are non-invasive, meaning they don’t require cutting into your body. Several different imaging methods may be used.^[1]

An ultrasound uses sound waves to create images of your liver. A CT scan, which stands for computed tomography scan, uses X-rays and computer technology to produce detailed cross-sectional images of your liver. These tests can show whether fat has built up in your liver and may reveal changes in liver size or texture.^[1]

More specialized imaging tests can provide additional information. FibroScan is a type of liver elastography that measures liver stiffness, which can indicate scarring or fibrosis. The stiffer the liver, the more likely it is that scarring has occurred. Magnetic resonance elastography and proton density fat fraction (MRE-PDFF) is an advanced test that both measures fat content in your liver and assesses liver stiffness to detect fibrosis.^[1]

These imaging tests are very helpful for identifying fat in the liver and detecting possible scarring, but they cannot always tell the difference between simple fatty liver and MASH with inflammation. This is where a liver biopsy becomes important in some cases.^[1]

Liver Biopsy

A liver biopsy is considered the most reliable way to diagnose MASH and determine how much damage exists in the liver. During this procedure, your doctor removes a small sample of liver tissue using a special needle. This sample is then sent to a laboratory where a medical pathologist cuts it into very thin slices and examines it under a microscope.^[1]

The pathologist looks for specific signs of MASH, including fat buildup, inflammation, cell damage, and scarring. The biopsy can determine the stage of fibrosis, which tells doctors how much scarring has occurred and how far the disease has progressed. This information helps guide treatment decisions and gives doctors a clearer picture of your prognosis.^[1]

Not everyone with suspected MASH needs a liver biopsy. Your doctor will decide if a biopsy is necessary based on your test results, symptoms, and overall health. While a biopsy provides the most detailed information, it is an invasive procedure that carries some risks, so doctors try to use non-invasive tests whenever possible.^[1]

Diagnostics for Clinical Trial Qualification

When patients are being considered for enrollment in clinical trials testing new treatments for MASH, specific diagnostic criteria must be met. Clinical trials have strict requirements to ensure that participants truly have the condition being studied and to create consistency across all people in the trial.^[10]

Clinical trials for MASH typically require confirmation of the diagnosis through liver biopsy. The biopsy must show specific features including steatosis (fat in the liver), inflammation, and ballooning of liver cells, with or without fibrosis. The amount of each of these features is often scored using standardized systems, and patients must meet minimum thresholds for each component.^[10]

Blood tests are also part of the qualification process. These may include standard liver function tests to measure enzyme levels, as well as tests to confirm metabolic conditions like diabetes or abnormal cholesterol. Some trials may also use non-invasive imaging tests like MRE-PDFF to measure liver fat content and stiffness as part of their enrollment criteria.^[10]

Clinical trials may exclude patients who have other causes of liver disease, such as significant alcohol consumption, viral hepatitis, or certain genetic liver conditions. This ensures that any changes seen during the trial are truly related to MASH and the treatment being tested, rather than other liver problems. Patients interested in clinical trials should discuss with their healthcare provider whether they might qualify based on their diagnostic test results.^[10]